Abstract [en]

Background: High demands are today placed upon Swedish elderly care nurses as more elderly live with multimorbidity while the hospital bed capacity is becoming lower.

Aim: The aim of the study was to explore nurses’ perception of decision-making in situations with acutely ill patients in nursing homes and which factors may influence the decision about transferring patients to the emergency department or not.

Method: This is a qualitative study with a phenomenographic approach. Semi-structured interviews have been conducted with 11 nurses working in nursing homes. The data analysis was based on Dahlgren and Fallsberg (1991) data analysis.

Result: Three different description categories were presented, which describes variations of the nurses’ perceptions.

Feeling comfortable in making the decision; which involved the nurses feeling confident in the decision-making about transferring patients to the emergency department or not.

Hesitant in making the decision; which described how nurses perceived the decision-making as problematic, with regard to transferring patients to the emergency department.

Many wishes to consider in taking the decision; which explained how nurses’ decision-making was influenced by requests from the patients or from people close to them.

Conclusion: The study reflected how supporting and aggravating factors could influence how nurses in nursing homes perceived the decision-making and how nurses have to take in consideration different opinions concerning the decision making process of transferring patients to the emergency department or not. The result could provide an idea of what support nurses need in order to avoid unnecessary patient transfer to the emergency department.